Trials of antihypertensive treatment - New agenda for the millennium

In 1968 a group of investigators from the US Veterans Association study rep orted that, compared to placebo, antihypertensive medication dramatically r educes morbidity and mortality in patients whose diastolic blood pressure w as 115 mm Hg or higher. Three years later a reduction of morbidity had also been demonstrated in subjects whose diastolic pressure ranged from 95 to 1 14 mm Hg. In the following decades these findings were confirmed in numerou s investigations of various populations. We now know that antihypertensive treatment is beneficial in mild hypertension, in isolated systolic hyperten sion, and in hypertension of the elderly. When it comes to the treatment of mild hypertension we will have to practice evidenceless medicine and act o n the internal logic of the issue. The logic suggests that many present-day antihypertensive agents are harmless, that over the long term they may pre vent target organ damage, that early intervention may be more beneficial th an late treatment, and, finally, that treating mild hypertension may have a major positive impact on public health. Am J Hypertens 2000;13:11S-17S (C) 2000 American Journal of Hypertension, Ltd.